The URL can be used to link to this page

Home My WebLink About01-02-13COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 016989 COLE JUDITH K 600 CARBON AVE HARRISBURG, PA 17111 -------- fold ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0002 DECEDENT NAME: DAUGHENBAUGH SUSAN DATE OF PAYMENT: 01 /02/201 3 POSTMARK DATE: 12/31 /2012 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 8/201 2 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 12168455 $75.07 TOTAL AMOUNT PAID: $75.07 CHECK# 5210 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES Pennsylvania ion Noticee Tax PD BDx zao6ul Informat HARRISBURG PA I7I2E-o6ol And Taxpayer Response .. :~ - Q _ g `; i.EC~6'f _ ~ ~. .,~-~~ - ~, ~ ~, ~~n _,~ {~~~~ ~ ~ ~. :.~~.L ~3 d~ai V ~.. [n, ~ F^' `E V 9 ~ 11 y 600ICARBONOAVE ~~~~~,~-~' ° `~ '` ~ HARRISBURG PA 17111-45~~ -- Pennsylvania DEPARTMENT OF REVENUE ~~---~'"~ REV-1543 EX DocEXEC COB-12> FILE NO. 2170 :%=~-~~~ D~~'L ACN 12168455 DATE 12-19-2012 Type of Account Savings Estate of SUSAN DAUGHENBAUGH X Checking SSN 195-34-6073 Trust Date of Death 11-18-2012 Certificate County CUMBERLAND e artment with the information below indicating that at Ih e d f eta of the PsECU provided the d p ve-named decedent you were a joint owner or beneficiary of the account abo Remit Payment and Forms to: Account No. 195346073 REGISTER OF WILLS Date Established 11-09-1988 1 COURTHOUSE SQUARE Account Balance $ 3,950.92 CARLISLE PA 17013 Percent Taxable X 16.667 Amount Subject to Tax $ 658.50 Tax Rate X 0.120 NOTE*: If tax payments are made within three months of the i I Tax Due $ 79.02 decedent's date of Beat X, due will become delinquent n ne mo the Potent a due. Any inheritance to With 5% Discount (Tax x 0.95) $ (see NO`,TE*) ~ after the date of death. .~ % ~~ ~ PART CJtep 1 ;Please check the appropriate boxes below. 1 m the s ouse of the deceased or I am the parent of a decedent w o was A ~ No tax is due. I a P 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent g ~ The information is correct. with my response. Proceed to Step 2 on reverse. Do not check any other oxes. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or deob~ ate and the back f th s porm. Complete Part 2 and part 3 as app p bove-identified asset has been or will be reported and tax paid with the PA Inheritance Tax The a Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pa the dedu B. You paid the debts after the death of the decedent and can furnish proof of payment if re uest ctible items. (If add~t~onal space is required, you may attach 8 1/2" x 11"sheets of paper.)ed by the department. please obta n a written correct on f om thelfinanc al~institut on~and count balance (Line 2), or percent taxable (Line 3 1. Enter the date the account was established or titled as it existed at the date of death this form. )° 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percenta a tax by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners ble is 100% divided = 25%, etc.) 33.33%, 4 owners b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiari 4. The amount subject to tax is determined by multiplying the account balance by the percent taxabl es. 5. Enter the total of any debts and deductions claimed from Part 2. e' 6. The amount taxable is determined by subtracting the debts and deductions from the amount su 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. blect to tax. If indicating a different tax rate, please state your relationship to the decedent: ~ffjCjal 1.1Se QnJy (~ AAF 1 • Date Established 1 PA Department Df Revenue 2. Account Balance 2 $ PAID 3. Percent Taxable 3 X 4• Amount Subject to Tax 4 $ 2 5. Debts and Deductions 5 - 3 6. Amount Taxable ~ s $ 5 ?. Tax Rate ? X S 8. Tax Due 8 $ 9. With 5% Discount (Tax x .95) 9 X ~ Step 2: Sign and date below. Return TWO com along with a check for an pleted and signed copies to the Register of Wills listed on the front of this form, y payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and com belief. plete to the best of my knowledge and Work ~ ~' " Home ( .. 5'~ _ ? ~5 ~ /~ ~~ T ayer Signature a~ ~--~ Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE COUNTY REGISTER OF WILLS, PA 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEA HERITANCE TAX DIVISION AT ONLY: 1-800-447-3020 RING AND/OR SPEAKING NEEDS Date Paid Pa"AA F ~ ~' 1. ~ ,.~... 2012 '~ ' 3 `' ~y- pup. > ;: W O i '.'y_. ,~~., ^r ~ ~ . ~!'y -'~~z~} _ ~ r =i ~,s: ~~ r~,, - p' ~~ Q ~~~ 1 l'' i ~ F\ 'a J 0 E' ` ! . ~^ ; W • _..... ~..~ V ~ __.,fF ~~ 6..t.1 ~ ~b i~L:, :> ~.~ ~ v ,~~ ~ r~. ~ ~~' i ~/ f ,_,+ ~'~: i r,,, ~ y i"~ ,~ ~'^ ~ O Q U ~. d f~ ~ ~ ~^ '"_ ~ ~ .y ~ J "~ ~ ~ , • .~,-,r r , ;~ ~Fryryaa~~Z}} :r" 3 S1 ;~ Ly ~~• ~~i ~~.d •,i i•~ •t